Chronic rhinitis and rhinosinusitis (CRS) are relevant health conditions affecting significant percentages of the western population. They are frequently coexisting and aggravating diseases. Both are chronic, noninfectious, and inflammatory conditions sharing to a certain extent important pathophysiologic similarities. Beneficial effects of probiotics are long known to mankind. Research is beginning to unravel the true nature of the human microbiome and its interaction with the immune system. The growing prevalence of atopic diseases in the developed world led to the proposition of the “hygiene hypothesis.” Dysbiosis is linked to atopic diseases; probiotic supplementation is able to alter the microbiome and certain probiotic strains have immunomodulatory effects in favour of a suppression of Th-2 and stimulation of a Th1 profile. This review focuses on randomized, double-blind, placebo-controlled trials investigating clinical parameters in the treatment of chronic rhinitis and CRS. An emerging number of publications demonstrate beneficial effects using probiotics in clinical double-blind placebo-controlled (dbpc) trials in allergic rhinitis (AR). Using probiotics as complementary treatment options in AR seems to be a promising concept although the evidence is of a preliminary nature to date and more convincing trials are needed. There are no current data to support the use of probiotics in non-AR or CRS. 1. Chronic Rhinoconjunctivitis and Chronic Rhinosinusitis ARIA guideline defines rhinitis as a chronic inflammatory disease of the nose resulting in nasal symptoms including nasal obstruction, sneezing, and anterior or posterior rhinorrhea (occurring during two or more consecutive days for more than one hour) [1]. Allergic rhinitis (AR) is the most common form of noninfectious, chronic rhinitis affecting more than 25% percent of the European population [1, 2]. It is characterized as an eosinophilic, IgE-mediated, Th-2 dominated immune disorder. “Local allergic rhinitis” describes a condition of local allergen-specific IgE production in the nose. Prevalence data are estimated to lay between 47% and 62.5% of patients with perennial and seasonal symptoms. Interestingly, this condition is described to precede a “classic” AR [3]. Prevalence data about nonallergic forms of chronic, noninfectious rhinitis are rare. They are estimated to be almost as high as AR [1]. Non-AR includes a long list of potential causes. However, the idiopathic form remains the most frequent [4]. Although non-AR is per exclusion not a type-I allergy it resembles often the same
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